Provider Demographics
NPI:1992914741
Name:CHAMBERS, MARILYN J (MA LPC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 2ND AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2452
Mailing Address - Country:US
Mailing Address - Phone:541-485-9295
Mailing Address - Fax:541-942-2759
Practice Address - Street 1:400 E 2ND AVE STE 106
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2452
Practice Address - Country:US
Practice Address - Phone:541-485-9295
Practice Address - Fax:541-942-2759
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO910101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORYJ28401OtherPACIFICSOURCE